Total Knee Replacement. Is there a perfect time?

[ijan]

Hi I'm new to this forum and scheduled for a TKR in three weeks.

I've had numerous ligament reconstructions and preety much all my cartilage removed from one knee following a sports injury when I was 19. Now 66, I've been bone on bone for eight years but currently manage to walk around four miles a day.

I am not pain free and the slightest slip can cause my knee to flare up to the point where I can't bear weight for weeks. It was after such a flare up that I decided the time had come to go on the waiting list and get a new knee. Six months on, and with no recent flare ups, I'm starting to feel a few pre op jitters.

I'm pretty active and love sea kayaking.

Any thoughts? Positive experiences of returning to activity after TKR especially welcome. Also any tips to aid recovery.

Thanks

[MikeG1944]

If you Google 'Stem Cell Therapy' and look on the NHS site it may be of interest to you, although the procedure is only available at Basildon and Southampton hospitals in the UK.

[ijan in reply to MikeG1944]

Thanks, I'll take a look.

[Hidden]

Hi ijan,

Lots of thoughts, sadly not all positive but my outcome was. Afraid that's the nature of the beast ... dammit !

I have a background similar to yours ................. bear with me while I run through it ........ at high school (1960’s) I was an avid long jumper and high jumper. High jump I excelled at and my take off leg was my right leg.

In 2000 (aged 56) I tore my right knee cartilige while out walking my dog and stumbled. Bingo ! This was followed by cartilige removal and whilst doing the business the

surgeon found the onset of osteo arthritis. So a general clean up occurred.

The years that followed saw the knee change and it ended up bone on bone and with osteoarthritis, not only that but it changed the knee tilt, instead of being level it tilted inward from the outer part to the inner part which damaged the medial compartment.

A bonus to all this was that this damage changed the whole leg geometry and I ended up with years of worsening pain from the right lower back and specifically from the right Sacrililliac Joint (Si joint).

By June 2015 I was pretty much crippled with pain and a normal walk of 10 minutes duration downhill was now taking 30 minutes. The return walk had to be by taxi.

So, on 6 Nov 2015 (age 71) I had a partial knee replacement, right knee, medial compartment.

Although retired I have continued working as a bus driver, and after a period of

convalesance/rehabilitation I returned to work on 26 January 2016. So, at 8 weeks I returned to driving my (manual) car and at 11 weeks I returned to my job bus driving which I still do.

Thoughts and tips. Hmmmmm ..... Consciously or otherwise you have probably been treating your knee with respect, that is you may have avoided doing ‘the stuff’ that aggravates it. Even small ‘stuff’ will calm it down. But don’t be fooled ........ it is worsening and one day you’ll be in real agony.

My view is - stay on the waiting list and do the business !

I did and wished I’d had it done earlier. I am in Cornwall UK and was admitted as an NHS patient and operated on in a Private hospital. Brilliant.

In 3 days, then home. I also have a heart arrythmia and am on some ‘dirty’ drugs, nonetheleast of which is Warfarin. No problems.

There are several keys to this whole process.... you must find the right pain relief, without it it will impair your ability to exercise your operated leg. Warfarin for me imposed alot of restrictions and the only pain relief that worked that didn’t work against the effects of Warfarin was Co-Codomol 30/500 (prescription grade).

Then you have to dedicate your first 8 weeks to 12 weeks of post op life to exercises. Exercise until you are bloody well going bonkers with exercises. I managed also to get out and walk unaided along the rugged Cornish South West Coastal Path also at about 8 weeks.

Must say my surgeon was brilliant and realigned my whole leg geometry so that now I have no lower back pain or pain from the right Si joint. 2 fixes for the price of one, so to speak

I also found weekly visits to a sports injury massage therapist brilliant .... I did this the moment my dressing was removed and the incision line and general area was cleared of infection.

She massaged - seriously, vigourously massaged the incision scar line and surrounding area. The purpose of this was to break up, and eliminate the possibilty of the operated area forming scar tissue deep inside. She used Aloe Vera Gel as the lubricant.

ESSENTIAL ......... once scar tissue forms inside, your ability to carry out your exercises will be seriously, seriously impaired and therefore so will your recovery and your future well being.

Youtube has some very useful videos on Post Op recovery and exercises following partial and total knee replacements. Nowadays I am pain free. My knee feels normal but I am aware that there is something unnatural with my right operated knee compared to my left natural knee.

Probably the worst activity in terms of comfort is kneeling. So any household tasks that require the kneeling position, require a cushion under the knee but that's about it.

That's my stuff for you to consider. Get back if you have any queries.

John

[ijan in reply to Hidden]

John,

Thankyou for your thorough reply.

Great to hear that you were able to pick up your life and get back to driving professionally.

I haven't been able to knee for years and find getting out of my kayak a challenge as I lack the power to stand from a squat on my dodgy knee.

Much of what you say resonates with my own situation.

My original injury was sustained when I trriple jumped into an unraked sand pit at the tender age of 19. Years of knee instability, and failed ligament reconstuctions, followed; until a brilliant surgeon at the RNOH managed to stabilze my knee. While not perfect, or pain free, I could climb, cave, kayak and walk!

Interesting that you mention lower bak pain; this is somthing I've suffered increasingly over the last couple of years. Also, I know I favour my good leg making it work twice as hard particularly when ascending or decending.

I was on rivaraxoban when a small slip resulted in a mega flare up last August. My whole leg turned black and blue from the top of my thigh to my ankle and was swollen over the same range. I couln't weight bear for weeks. Now, six months later, and just over two weeks from TKR , I'm back to walking 4 or 5 miles a day and agonising over the timing of the procedure.

Like you I'm due to have my op at a private hospital as a NHS patient. I have great faith in my consultant who performs hundreds of knee replacements each year and also successfully repaired the cruciate ligament on my other leg. He first offered TKR 8 years ago but always left it to me to decide when I was ready. My last flare up resulted in four days in hospital. I was in a remote location where the local hospital looked after me overnight before sending me by air ambulance to thier parent hospital 70 miles away.

You're suggestion for post op sports massage is one I will follow up.

Did you have your op under a spinal block?

Did you use ice packs/gel or an ice machine after the procedure?

Did the AF pose any problems for the procedure? I know my surgeon hates rivaraxoban and plans to substitute sanother thinner a week before the procedure.

Thanks again!

Jan

[Hidden]

I'm afraid ai've never had a knee relacement, so can't help you. Just wanted to wish you best wishes whatever happens.

[ijan]

Thanks

[Hidden]

Hi Jan,

You talk of your lower back pain and also favouring your good leg .... yep been there done that. .... well its like this. And I'm sure with your sporting background you'll understand when I say, forget about the body per se, focus on the mechanics of the bones and the pure geometry of it all. Then focus on the tissue, and preventing the scar tissue from forming. I'm sure your surgeon will consider your skeletel structure and geometry when he fixes you up. But you could always ask him about it. What a bonus I had, new knee and no more Si joint pain and lower back pain. Joy !

No spinal block, (I had a GA) but then I never asked for one nor did the surgeon suggest it. Maybe to do with AF I don't know. My sister had a total knee replacement and hers was under spinal block, but then she doesn't have AF.

Yes, I used ice packs. Our fridge/freezer worked overtime producing ice packs for me ! I used these all the time, before and after exercises BUT especially after exercises. Focus on pain control. Essential for you to get on top of that to do the exercises. I am one of those who hates taking medication particularly with the party bag of drugs I have anyway and so I tended to keep my pain killers to a minimum ....... stupid boy ! I soon learned that there was nothing wrong with pain killers as that gave me pain relief and enabled me to do exercises. I spread my exercises out throughout the 24 hours a day and spread my pain killers out similarly.

AF ..... no problems whatsoever, and the little gremlin in my heart electronics didn't give me any grief at all. I have always been on Warfarin, Warfarin and me are the very best of buddies - I self test for my INR and if it gets outta kilter I either change my green veg intake or adjust my own dose. I'm unbelievably INR stable.

I stopped Warfarin a week before surgery. I was carved up at about 11 am and came round in my room mid afternoon. They then whacked two injections of a bridging anticoagulant (Fragmin) into my tummy area, then at 8 pm that night I resumed my normal dose of Warfarin again, and have maintained that ever since. Simply, just no problems.

Apart from a Statin and BP medication which I'd been on for years prior to AF the only medication I'm on for AF is the Warfarin and also for heart rate control is Bisoprolol. The rest I follow a food/nutrition plan to control the AF because my AF is from the vagal nerve. I have found if I calm my gut I calm my heart. A natural progression. I have had only one AF event since April 2015 ........ and that occurred as I was sleeping on my left side. It lasted some 5 hours never to return. My blood pressure took another 21 hours to stabilise and return to normal.

Hope all this helps, hope you don't cancel out and when its done I really hope you can get back to your outdoor activities and enjoy them again. If you go ahead and get it done and wanna get back to me post op just get on here and PM me.

May the force be with you.

John

[ijan]

Sound advice.

Thankyou; you have no idea just how much it has helped. I'll pm after the op.